| Organization Name: | BREWERTON VOLUNTEER FIRE DEPARTMENT AMBULANCE INC |
| NPI Number: | 1073750766 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACIE MAILLOUX (PRESIDENT) |
| Mailing Address: | 9625 Brewerton Rd Brewerton |
| State: | NY US |
| Postal Code: | 130290708 |
| Phone Number: | 3156689789 |
| Fax Number: | 3154288648 |
| NPI Enumeration Date: | 01/16/2009 |
| NPI Last Update Date: | 10/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 11319 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |